Management of exposures to blood borne pathogens

Ottawa Public Health recommends health care professionals provide comprehensive assessment and management of all persons with a potential non-sexual exposure to blood or body fluids which may be infected with hepatitis B (HBV), hepatitis C (HCV) and/or human immunodeficiency virus (HIV).

A blood borne exposure may occur when a person, "the Exposed", is exposed to the blood or body fluids of another person, "the Source", through:

Percutaneous Injury

  • needle stick
  • cut from a sharp object
  • human bite that breaks the skin

Mucous Membrane Splash

  • eye
  • nose
  • mouth

Non-Intact Skin

  • chapped
  • recent scrape
  • dermatological conditions

The types of body fluids that can transmit HBV, HCV and HIV include:

  • blood and all biologic fluids visibly contaminated with blood
  • organ and tissue transplants
  • pleural, amniotic, pericardial, peritoneal, synovial and cerebrospinal fluids
  • uterine/vaginal secretions or semen (unlikely to transmit HCV)
  • saliva (saliva alone transmits only HBV, but if saliva is contaminated by blood it may also transmit HCV and HIV)

Note: HBV, HCV, and HIV are not transmitted by feces, nasal secretions, sputum, tears, urine and vomitus unless visibly contaminated with blood.

Steps for managing a potential exposure to blood borne pathogens

 Provide Immediate Care to the Exposure Site

  • Allow injury to bleed freely
  • Remove clothing that is contaminated with body fluids
  • Thoroughly flush exposed area with water or saline
  • Clean area with soap and water and then dry
  • Notify supervisor or delegate, if applicable
  • Assess type of exposure (i.e. percutaneous injury, mucous membrane or non-intact skin exposure)
  • Assess type of fluid (i.e. blood, visibly bloody fluid, other potentially infectious fluid or tissue)
  • Assess length of time since fluids left Source's body in minutes
  • Determine if an exposure has occurred:
  • If no exposure has occurred, notify the Exposed and counsel/reinforce infection prevention and control practices
  • If an exposure has occurred, serologic testing should be performed

Conduct a Risk Assessment of the Exposure

Serologic Testing for HBV, HCV and HIV

  • Obtain consent from the Exposed to do baseline and follow-up serologic testing for HBV, HCV and HIV
  • Baseline includes antibody to HBV (anti-HBs, anti-HBc) and antigen (HBsAg), HCV and HIV
  • Repeat HBV at 6 months
  • Repeat HCV at 3 months and 6 months
  • Repeat HIV serology at 6 weeks, 3 months and 6 months (if negative on previous testing)
  • Encourage the Exposed to be immunized for hepatitis B if not previously received

Counsel the Exposed

While waiting for serology results, the Exposed should:

  • Abstain from sexual intercourse or use a latex condom
  • Not donate blood, plasma, organs, tissue or sperm
  • Not share toothbrushes, razors or needles that may be contaminated with blood or body fluids
  • Not become pregnant
  • Discontinue breastfeeding, pump breast milk and discard until serology results become available

Post-Exposure Prophylaxis (PEP)

Treatment to prevent infection following an exposure to blood or body fluids is called PEP. PEP is available for HIV and HBV but not HCV and is only provided in hospital emergency departments. If an exposure has occurred, the Exposed must be referred to a hospital emergency department as the decision to recommend PEP is based on the assessment of the attending emergency physician. If the Exposed is started on PEP, a referral should be made to The Ottawa Hospital, General Campus Infectious Diseases Clinic to obtain serology testing results and ensure comprehensive follow-up.

PEP for HIV usually consists of treatment with 2 to 3 antiretroviral drugs for four weeks. PEP should begin as soon as possible after the exposure, preferably within hours after the exposure. Treatment may be considered at later intervals because of the potential benefits of early treatment of HIV infection should seroconversion occur. If the Source HIV test result is negative, PEP is discontinued immediately.

PEP for HBV consists of treatment with hepatitis B immune globulin (HBIG) and hepatitis B vaccine, depending on the exposed person's susceptibility or immunity to HBV infection.  HBIG should be administered within 24 hours. 

Risk of Transmission of HBV, HCV and HIV

Several factors influence the risk of infection from a single significant exposure, including:

  • The virus involved (HBV & HCV are more infectious than HIV)
  • The type of exposure (a deep injury is more risky than a splash to the eyes)
  • The  amount of blood involved in the exposure (more blood is associated with more risk)
  • The amount of virus in the Source's blood at the time of exposure (more virus is associated with more risk)

Hepatitis B Virus (HBV)

For persons who have received Hepatitis B vaccine and have developed immunity to the virus there is virtually no risk for infection. The risk of transmission of HBV following a needle stick or cut exposure (from an infected source) is 6-30%. In the case of human bites where the skin is broken, the risk of transmission (to the person who is bitten) is unknown but is likely to be quite low since the concentration of HBV is 1000 times lower in saliva than in blood. The management of persons with possible exposures to HBV is outlined in the Canadian Immunization Guide, 7th edition (2006), page 193-196.

Hepatitis C Virus (HCV)

The risk of acquiring HCV following a needle stick or cut exposure to an infected source is approximately 1.8%. The risk of infection from an exposure to mucous membranes or non-intact skin is unknown, but is believed to be very small. There is no vaccine against HCV and no treatment available after an exposure that will prevent infection. Immune globulin and antiretroviral drugs are NOT recommended after exposure.

Human Immunodeficiency Virus (HIV)

The risk of acquiring HIV following a needle stick or cut exposure to an infected source is currently estimated at 0.3% (1 in 300). The risk after exposure of the eye, nose, or mouth to blood infected with HIV is estimated to be approximately 0.1% (1 in 1,000). The risk after exposure of non-intact skin to blood infected with HIV is estimated to be less than 0.1%. A small amount of blood on intact skin likely poses no risk at all.

For more information, you can contact the Communicable Disease Control Program at 613-580-6744 ext 24224.


1. Exposure to Blood, What Healthcare Personnel Need to Know, Department of Health and Human Services and the Center for Disease Control, Atlanta, Georgia, 2003

2. Occupational Exposure to HBV, HCV, or HIV, Canadian HIV/AIDS Legal Network, 2001

3. Canadian Immunization Guide, National Advisory Committee on Immunization, Public Health Agency of Canada, 7th edition, 2006

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